頭頸部扁平上皮癌における血漿中の循環腫瘍DNAと腫瘍DNA解析の有用性

広島大学(Hiroshima University)博士(医学)Doctor of Philosophy in Medical Sciencedoctora

A Case of Primary Osteosarcoma of the Mandible That Responded to Preoperative Chemotherapy: p16 as a Potential Prognostic Factor

We report a case of mandibular osteosarcoma in a Japanese woman in her 70s who was p16-positive. Despite the rapid growth of the tumor, the patient responded well to chemotherapy and was then able to undergo surgery. Head and neck osteosarcoma (HNOS) is a very rare cancer, and although the importance of surgery has been pointed out, the effectiveness of chemotherapy is unclear. Resection margin negativity and response to chemotherapy have been reported as prognostic factors; another report assessed the effectiveness of the immunohistochemical expression of p16 protein as a predictor of response to chemotherapy

Baseline Neutrophil-to-Lymphocyte Ratio and Glasgow Prognostic Score are Associated with Clinical Outcome in Patients with Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma Treated with Nivolumab

Recurrent or metastatic head and neck squamous cell carcinoma (R/MHNSCC) has a poor prognosis. Although nivolumab is approved in Japan for treating R/MHNSCC, the response rate is low. Therefore, identifying pretreatment prognostic factors is necessary. This study assessed the utility of the neutrophil-to-lymphocyte ratio (NLR) and Glasgow Prognostic Score (GPS) as biomarkers of response to nivolumab. We retrospectively collected the data of 56 R/MHNSCC patients treated with nivolumab between May 2017 and December 2019. The Kaplan–Meier method and log-rank test were used to estimate overall survival (OS) and progression-free survival (PFS), and multivariate Cox hazard regression analysis was used to identify independent predictors of survival. Patients with a low pretreatment NLR had prolonged OS, and patients with a low pretreatment GPS had increased OS and PFS. A performance score (PS) of 0-1, development of immune-related adverse events, and GPS of 0-1 were significantly associated with OS in multivariate analysis. In summary, baseline pretreatment NLR and GPS are independently associated with OS in R/MHNSCC patients treated with nivolumab. Administration of nivolumab while maintaining the PS reflects a immune status of the host and leads to a good OS

Ganglioneuroma in The Neck Region: A Case Report

Ganglioneuroma, which rarely occurs in the neck region, is a well-differentiated benign tumor of the sympathetic nervous system. A 39-year-old man presented with neck swelling for a year. A giant tumor was located on the left side of the neck. Schwannoma was suspected on preoperative cytology and core needle biopsy, and the postoperative diagnosis on pathological examination was ganglioneuroma. The origin of the tumor was considered to be the sympathetic nervous system based on the postoperative appearance of Horner’s syndrome. The treatment choice for ganglioneuromas is complete surgical resection, contrary to the nerve-sparing resection of schwannomas. Therefore, making the definitive diagnosis before surgical resection could be important. In this report, we focus on the differential diagnosis obtained with radiological findings and the treatment strategy for the tumor with a literature review

Evaluation of Role of Prophylactic Swallowing Rehabilitation in Chemoradiotherapy for Advanced Head and Neck Cancer Using Novel Software Analysis of Videofluorography Images

Concurrent chemoradiotherapy (CRT) for head and neck cancer (HNC) is associated with substantial side effects, most notably those related to swallowing function. Recently, early implementation of protective exercises has been recommended as an important intervention in patients treated with chemoradiotherapy. Several studies, including randomized controlled trials, have evaluated prophylactic swallowing exercises and swallowing outcomes. Although several clinical outcome measures to assess the severity of swallowing dysfunction are available, they are indirect measures. Videofluorography is the most popular and efficient examination that visually demonstrates the dynamic state of swallowing. This study aimed to determine whether prophylactic swallowing rehabilitation provided to HNC patients receiving CRT would result in better swallowing outcomes. Thirty patients were enrolled in this study. Fifteen patients (the control group) received swallowing rehabilitation after CRT on demand, and the other 15 (the rehabilitation group) received prophylactic swallowing rehabilitation from the beginning. Swallowing motion was evaluated with motion analysis software. There were statistically significant differences in hyoid bone displacement, duration of swallowing onset, larynx elevation time, and total swallowing time between the control and rehabilitation groups. Based on the results of this study, prophylactic swallowing rehabilitation seems to reduce the extent and severity of the functional problems that occur after CRT.This study was supported in part by Tsuchiya Medical Foundation Grant (no. 3010281)

Effectiveness of Expanded Instantaneous Input Dynamic Range Adjustment on Speech Perception

Instantaneous input dynamic range (IIDR), as defined by Cochlear Ltd. (Sydney, Australia), refers to the acoustic level of short-term input dynamic range (IDR). Our aim was to evaluate the efficacy of expanding IIDR to improve speech understanding. We enrolled 11 unilateral Cochlear Ltd. patients with post-lingual hearing loss. The two types of IIDR settings (T-SPL/C-SPL of 25/65 dB (default IIDR) and 25/80 dB (wide IIDR)) were blindly assigned, and only one IIDR setting selected according to their preference was used for at least three months. Each IIDR group was evaluated with both default and wide IIDR conditions using the recorded word and sentence test materials of the Japanese CD speech discrimination scoring system (CI-2004 test) in quiet and noise with a signal-to-noise ratio (SNR) of +10 dB, presented at 65/80 dB SPL. Wide IIDR significantly improved speech perception in all tests, except for sentences in quiet conditions at a presentation level of 65 dB. Improvements during loud conversations in noisy environments were obtained without any adaptation period. Wide IIDR should become a new individual configuration setting method in Cochlear Ltd. devices to improve hearing in loud conversations and noisy environments

Severe Type 2 Inflammation Leads to High Platelet-Activating-Factor-Associated Pathology in Chronic Rhinosinusitis with Nasal Polyps—A Hierarchical Cluster Analysis Using Bulk RNA Barcoding and Sequencing

Platelet-activating factor (PAF) is a phospholipid-derived inflammatory mediator that triggers various inflammatory conditions, including eosinophil activation and recruitment. This study aimed to evaluate the expressions of PAF-metabolism-associated genes, namely genes coding the enzymes involved in PAF synthesis (LPCAT1, LPCAT2, LPCAT3, and LPCAT4), PAF degradation (PAFAH1B2, PAFAH1B3, and PAFAH2), and the gene for the PAF receptor (PTAFR) in subtypes of CRSwNP classified by clinical- or hierarchal-analysis-based classifications. Transcriptomic analysis using bulk RNA barcoding and sequencing (BRB-seq) was performed with CRSwNP, including eosinophilic CRS (ECRS) (n = 9), nonECRS (n = 8), ECRS with aspirin-exacerbated respiratory disease (Asp) (n = 3), and controls with a normal uncinate process mucosa (n = 6). PTAFR was only upregulated in ECRS and nonECRS. In the hierarchical cluster analysis with clusters 1 and 2 reflecting patients with low-to-moderate and high levels of type 2 inflammation, respectively, cluster 1 exhibited a significant downregulation of LPCAT2 and an upregulation of PTAFR expression, while cluster 2 showed an upregulation of LPCAT1, PAFAH1B2, and PTAFR and downregulation of PAFAH2 expression. Understanding this strong PAF-associated pathophysiology in the severe type 2 inflammation group could provide valuable insights into the treatment and management of CRSwNP